Provider Demographics
NPI:1982276168
Name:COULIBALY, YEHONRI MARTIN (RN)
Entity Type:Individual
Prefix:
First Name:YEHONRI
Middle Name:MARTIN
Last Name:COULIBALY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 MOUNT HOPE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2911
Mailing Address - Country:US
Mailing Address - Phone:585-642-2944
Mailing Address - Fax:
Practice Address - Street 1:1174 MOUNT HOPE AVE APT 2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2911
Practice Address - Country:US
Practice Address - Phone:585-642-2944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY803416163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse